Alessandro Spirito

From Genova 🇮🇹 | Cardiologist trained in Bern🇨🇭| Research Fellow @Mountsinaiheart NY 🇺🇸🗽

[Davide Capodanno @DFCapodanno]

The 10 trials I am most looking forward to at the ESC Hot Lines next week (in no particular order):

LIBREXIA-ACS, where milvexian could end up like apixaban in APPRAISE-2, perhaps with less bleeding. Rivaroxaban did not exactly have an easy story after ATLAS ACS 2 either, despite the positive results. Although we know the trial was stopped for futility, the data remain important in the rollercoaster of FXI inhibitor trials.

EPIDAURUS, because I will be the Discussant in Hot Line 3. It compares ticagrelor or prasugrel with clopidogrel in patients with atrial fibrillation and acute coronary syndrome. So I know everything about it, but I am not telling you.

SWITCH-SWEDEHEART, because if this trial is positive for prasugrel, this might finally be the moment when I call back all my patients on ticagrelor and switch them one by one. If not, we can say we have been joking all along and that ISAR-REACT 5 was just an episode.

PREMIUM, because after NEOMINDSET and STOPDAPT-3, a third negative trial for an aspirin-free strategy (meaning P2Y12 inhibitor monotherapy from the outset) would probably put this rather radical idea to rest, making it indefensible.

ISOLEDS, comparing OCT- versus IVUS-guided PCI in distal left main disease. After OPTIMAL and IVUS-CHIP, which we are still recovering from, we really need something that leaves angiography out of the comparison.

TAVI-PCI, because I don’t know about you, but after NOTION-3 and PRO-TAVI, I am still somewhat confused.

POPular-ACE, one of my favourites because it addresses a simple question with a potentially clear answer that we could implement in the cath lab the very next day: do we actually need protamine after TAVI or not?

AIR-STEMI, continuing the elemental saga of the Ferrara group (the same investigators behind FIRE) this time using angio-derived FFR to identify non-culprit lesions in STEMI. There is some confusion here too, given that FLOWER-MI was negative while FRAME-AMI was positive.

A-CLOSE, evaluating chronic clopidogrel monotherapy and continuing the story started by HOST-EXAM and SMART-CHOICE 3 against aspirin, while resembling OPT-BIRISK in its comparison with DAPT.

PRAGUE-26, which deserves a special mention because I really like the idea of tackling a complicated problem with an extremely simple and inexpensive approach. The results could surprise us and tell us that the solution has been sitting right there all along: alteplase directly instilled into the pulmonary arteries—a strategy we practically never use, and perhaps we are wrong not to.

[Susie Sun @SusieSu11733465]

#RCM Sharing a New Review🌟

"Recent Advances in the Treatment of #Coronary In-Stent #Restenosis"
from @mauro_gitto, @AngeloOliva3, @Drroxmehran, @RaberLorenz, @AlessSpirito et al.

#ISR #stent #revascularization #PCI #DES

📤Full Text:
https://t.co/sil0t4c0iZ

[JACC Journals @JACCJournals]

Any spontaneous MI irrespective of troponin peak levels and procedural MI with #troponin elevation >35x are associated with ⬆️ mortality https://t.co/XnFj0HmGA4

#JACC #cvMI #PCI #cvAMI @Drroxmehran @KHERA_MD @AlessSpirito

[Davide Capodanno @DFCapodanno]

The balance between thromboprophylaxis and bleeding achieved by Factor XI inhibitors needs confirmation in trials powered for clinical endpoints. We reviewed the rationale, pharmacology, current results, and future perspectives of these novel compounds. https://t.co/vj7dZ3HCy8

[Alex Murphy @dralexcmurphy]

Acute coronary occlusion occurs in 20% of OOHCA and is a/w high risk of death. Fascinating work by @AlessSpirito. I look forward to reading the full paper! #TCT2022 @Drroxmehran @georgedangas

[Davide Capodanno @DFCapodanno]

Trials comparing P2Y12 inhibitors. Prasugrel and ticagrelor are first-line therapies for patients with ACS; prasugrel should be preferred to ticagrelor in patients undergoing PCI. Clopidogrel is an alternative for patients at high risk of bleeding. SWITCH trial ongoing. #TCT2022

[C. Michael Gibson MD @CMichaelGibson]

HALT: In pts with self-expanding TAVs, no relationship btw duration of implant and thrombus / inflammation scores. Neointimal thickening, structural change, and calcification scores increased with time. #TCT2022

[Dr Roxana Mehran @Drroxmehran]

Embolic protection with TAVR does NOT reduce all stroke!!! Diasbling stroke reduced but secondary endpoint!! #TCT2022 ⁦@crfheart⁩ #PROTECTTAVR

[Davide Capodanno @DFCapodanno]

With the evidence generated so far, we may safely conclude that PCI does not improve survival in patients with SIHD. PCI remains key in ACS, and for the improvement of PROMs in consideration of patient compliance and wishes in relation to the intensity of anti-anginals. #TCT2022

[Mount Sinai Fuster Heart Hospital @MountSinaiHeart]

We are pleased to announce that The Mount Sinai Hospital has been ranked No. 1 in New York City and No. 4 worldwide in #cardiology in @Newsweek's "World’s Best Specialized Hospitals 2023" list: https://t.co/reFjZkZvCs

#MSHeart @MountSinaiNYC

[Felice Gragnano @FeliceGragnano]

#PANTHER IPD:
❓P2Y12i (Clo/Tica) vs ASA in CAD patients:
👥N=24,325
💔P2Y12i ⬇️MACE by 12%
💔P2Y12i ⬇️MI by 23%
🩸Similar bleeding but ⬇️GI bleeds with P2Y12i
📊Evidence supports a #paradigm_shift toward P2Y12i monotherapy for secondary prevention of CAD.
@vlgmrc #ESCCongress

[MIЯVΛƬ #IC ༄ ｡° @mirvatalasnag]

#ESCCongress @PCRonline @escardio

📩#RadialFirst w & w/out PCI associated with reduction of all-cause mortality & major bleeding at 30 days compared w #TFA
📩☠️ benefit in patients w baseline anemia
📩Benefit persisted in subgroups eg women
@GargiuloG83
@SVRaoMD @ferdikiem

[C. Michael Gibson MD @CMichaelGibson]

ACT Outpatient Trial: In outpatients with symptomatic, lab confirmed COVID-19, colchicine and aspirin appear to provide no benefits in preventing disease progression or death across the spectrum of disease severity. #esc2022 #ESCCongress

[C. Michael Gibson MD @CMichaelGibson]

FOURIER-OLE studies: In pts w/ stable ASCVD, long-term use of evolocumab with median follow-up of more than 7 yrs appears safe and well-tolerated. Cardiovascular benefit shown by lower incidence of adverse events. #ESCCongress #ESC22

[C. Michael Gibson MD @CMichaelGibson]

APOLLO trial: In clinically stable COVID-19 patients w/ additional risk factors for thrombotic complications, treatment w/ apixaban 2.5 mg twice daily did not improve number of days alive and out of hospital. No major bleeding observed. #ESCCongress #esc2022

[Heart_BMJ @Heart_BMJ]

Long working hours, sedentary work, noise, night shifts and risk of ischaemic heart disease

https://t.co/1OHjeqI8nH

[Christopher O'Connor @coconnormd]

Terrific coordinating center leadership publishing11 simultaneous papers from DELIVER, majority lead by young investigators. The early full disclosure of the drug overall and in subgroups should lead to better implementation. ⁦@mvaduganathan⁩ ⁦⁦⁦@scottdsolomon⁩

[European Society of Cardiology @escardio]

#ALL_HEART trial: allopurinol has failed to reduce the primary endpoint of nonfatal myocardial infarction, nonfatal stroke or #cardiovascular death in patients with ischaemic heart disease.

#ESCCongress

[American College of Cardiology @ACCinTouch]

Findings from DELIVER presented at #ESCCongress & simultaneously published across @JACCJournals & others found dapagliflozin resulted in a lower risk of worsening #HeartFailure or death in patients w/ mildly reduced or #HFpEF. https://t.co/PW8r4pW0mL

[European Society of Cardiology @escardio]

#REVIVED trial: Percutaneous coronary intervention does not reduce all-cause mortality or #heartfailure hospitalisation in patients with severe left ventricular dysfunction and extensive #coronary artery disease.

#ESCCongress